Measuring the impact of a training intervention for early childhood centre staff on child development outcomes: Findings from a cluster randomized control field trial in rural Malawi.
Emma Jolley, Stevens Bechange, Mika Mankhwazi and 4 others
PMID 35112380WHAT IT FOUND
Training community childcare volunteers for 14 days, plus simple learning materials, did not significantly reduce children's developmental delay a year later in rural Malawi.
Language delay fell 3.2 points more in these centres, but that could be chance.
Key findings
01The training and materials package made no statistically significant difference to developmental delay about 12 months later: the differences between groups were -3.7 points for any delay (95% CI -9.6 to 2.1, P = 0.21), -3.2 points for language delay (-7.0 to 0.6, P = 0.09) and -1.8 points for social delay (-7.0 to 3.3, P = 0.48).
02Adjusting for how many caregivers and children each centre had, and whether it kept an attendance register or had play and learning materials, changed the estimates little and none of the results became significant.
03Average delay fell in both groups over the year: in control centres any delay went from 11.9% to 10.0% and in intervention centres from 11.4% to 6.4%.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The authors say the size of the study, in both centres and children, and the 12-month follow-up were limited by available resources, and a longer follow-up would be needed to see whether any effect persisted. They could not check whether the trained caregivers stayed in their jobs; if trained staff left, that would dilute any effect and mean the observed difference underestimates what full retention might have shown. Children were not followed individually: different children were assessed at baseline and endline, so the study describes what happened at the centres rather than change in the same children. Neither the caregivers nor the people collecting the data were blinded, and the developmental assessment partly used answers from parents. The groups differed at endline: intervention centres had more girls (63.4% vs 54.2%) and older children (54.8 vs 51.5 months), which the authors cannot rule out as an unintended consequence of the intervention. Three centres closed between baseline and endline, which the authors describe as underlining how precarious these community centres are. The training lasted only 14 days, which the authors say can cover only the most fundamental areas, and supporting caregivers to work more flexibly would need more extensive training.
Declared interests
The authors declare no competing interests. The work was funded by the UK Department for International Development and the Economic and Social Research Council. Nothing in the paper says the funders designed the study, analysed the data or wrote the manuscript.
The easy way to misread this
Do not read the fall in language delay as proof the training works. The difference between groups was 3.2 points and was not statistically significant (P = 0.09), with the confidence interval running from a 7.0-point reduction to a 0.6-point increase, so chance remains a plausible explanation. The authors themselves report no evidence of an effect on the primary outcomes, and intervention centres received learning materials as well as training, so any change could not be credited to the training alone.
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